Pancreatic Cysts: Risk Stratification and Follow-Up

Pancreatic cysts are increasingly identified due to the widespread use of advanced imaging techniques. While most cysts are benign, a subset can progress to malignancy, necessitating robust risk stratification and follow-up protocols. This chapter outlines the current approaches to evaluating pancreatic cysts, emphasizing risk stratification based on size, morphology, and the presence of high-risk features such as main duct involvement, mural nodules, or solid components. Guidelines from leading organizations, including the American Gastroenterological Association (AGA), the International Association of Pancreatology (IAP), and the European Evidence-Based Consensus, are summarized to provide clarity on diagnostic and surveillance strategies. Patients with low-risk cysts, such as those under 3 cm without worrisome features, are often managed conservatively, with periodic imaging recommended to monitor for changes. High-risk cysts, defined by specific imaging findings or concerning clinical symptoms, require further evaluation with endoscopic ultrasound (EUS) and, in some cases, surgical consultation. The chapter highlights the balance between avoiding overtreatment of benign cysts and ensuring timely intervention for malignancy-prone lesions. Recent advances in biomarkers and genetic testing, along with imaging modalities, are discussed as emerging tools for refining risk stratification. Surveillance strategies and intervals vary depending on cyst stability and risk profile, with many guidelines recommending discontinuation of surveillance after 5 years for stable, low-risk cysts. This comprehensive chapter underscores the importance of individualized patient care, multidisciplinary decision-making, and adherence to evidence-based guidelines in optimizing outcomes for patients with pancreatic cysts.